Who’s Ready for the Survey?

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It seems every week I am hearing that a unit is in survey and the surveyors are taking no prisoners.  My answer to a successful survey is, and always will be, PREPARATION. Being prepared for survey is not a one-time deal. It is something that is ongoing, not just when you are in your survey window.

I have to admit that when I was a Nurse Manager, a CNO, and now in my current roll, I kind of liked surveys. YIKES!!! Yep, I just said that.  I like surveys!  I know, everybody roll your eyes! I am sure you are thinking, is this lady being serious?! Don’t get me wrong.  It’s not like I dream about constantly being in survey. Surveys can be exciting, in a good way. Surveys are an opportunity to show off all the great work we do every single day.

When I first started in a leadership role I didn’t really know how to prepare for surveys. I had seen what my predecessors had done, so I just mimicked that. My first year as Nurse Manager was met with many challenges and survey was the #1 challenge. It wasn’t until I went through several, meaning a survey almost every other month for a year, that I figured out how to prepare for survey. I had no choice, except to learn fairly quickly all about regulations. I learned what happens when you are not meeting the regulations and what it looks like when you are meeting them.  The latter feels AWESOME!!

There are many things that units can do to prepare for survey.  I’d like to highlight the 3 top things to do. If you do these, it should create a domino effect and other things fall into place.

#1 Know your State, Federal and Accrediting agency (Joint Commission/DNV/HFAP) regulations.

Knowledge is power! Knowing your regulations is key to a successful survey. Read the regulations.  Be able to speak to them and implement them in your policies and practices. One of the biggest pitfalls I have seen is when healthcare providers challenge the regulations. Meaning, if they don’t like the regulation they spend too much time trying to figure out how to not follow it. That is not a great use of time or energy.  Simply put — not helpful.

As healthcare providers, we may not always agree with the regulations, but we still have to follow them. If you disagree with a regulation and spend time debating with others about it, you are wasting precious survey prep time. Regulations are put into place for a reason.  More often than not, it is for safety.  At times we disagree with a regulation simply because it’s a challenging one for us to meet. Maybe we don’t think we have enough staff. Maybe the cost to replace or fix something seems too great. Maybe we simply do not understand what the regulation is asking.

I encourage you to identify those regulations that you or your team is struggling with. Develop a committee, similar to a Performance Improvement team/committee. The committee’s goal is to figure out how you will meet the intent of the regulation. Again, keeping in mind that the team is not in place to discuss how much everyone disagrees with the regulation.

#2: Know your own policies.

 Policies and procedures are written for a reason. Sometimes it is a regulation from CMS, your state, your hospital’s accrediting agency (JC, HFAP/DNV) or your hospital’s own practices. Ultimately, policies are in place to help guide the care we provide in a consistent, quality-driven manner.

Make sure your staff know what your policies say and/or how to access them. I have had staff tell me they don’t even know how to access their own polices. Or maybe they can access the policies, but do not have a clue as to what they say. Sometimes I get the ever classic, “Huh, I have no idea what you are talking about.”

Most helpful tip I can offer here is—read your policies.

#3: Daily preparations.

 Audit the patient records:

I know that everybody reading this feels the same way I do about chart audits…We all LOVE THEM, right? Right? Ok, ok…everybody stop rolling your eyes. In all seriousness, I do love chart audits and for a very good reason.

Audits are an important part of the success of your survey. Surveyors tend to spend more time reviewing records than anything else. Knowing what is in the charts is key to fixing them. You need to be in your charts every day, not just the leaders of the unit, everybody. Nobody wants to sit down with a surveyor and begin reviewing records only to have the surveyor point out simple violations you had no idea were  being made.

Walk-through of the environment:

I read an article once that said, first impressions occur in the first 7 seconds of a meeting. A surveyor’s first impression of us and our unit is a big piece of a successful survey. In order to have a successful first impression, you have to be ready at all times. You need to know your unit. Knowing your unit is not the same as knowing the layout. It is about knowing where your vulnerabilities are every single day. This changes based on who is working that shift and what types of patients you have.

A daily walk-through is key. All staff, including leaders should be completing a walk-through every single day. You need to identify and fix any areas of concern. If there are items in the hallway, move them. Doors left propped open?  Lock them. Check all logs. Look for the overall cleanliness of the unit and make sure programming is running on time. There is nothing more frustrating and quite frankly embarrassing than walking the unit with surveyors and seeing things for the first time that could have been fixed.

So there you have it! Survey preparedness in a snap shot. Go forth and prep for survey!

Blog contributor: Becky Dvorak, Senior Vice President of Clinical Practice for Horizon Health

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